The COVID-19 pandemic dealt a heavy blow to health care systems around the world. As the number of patients with COVID-19 and secondary bacterial infections continued to rise sharply, experts in the global health community feared what the long-term impact of the crisis would be for already critical levels of antimicrobial resistance (AMR), especially in low- and middle- income countries.
Many assumed that AMR would increase substantially during the pandemic due to widespread changes in antimicrobial use (AMU). There were several factors to consider that impacted AMU, such as increased antibiotic use to treat (or prevent) secondary bacterial infections associated with COVID-19, along with incorrect prescribing of antibiotics for COVID-19 (a viral infection).
Conversely, increased attention to infection prevention and control measures (IPAC), and social distancing would lead to fewer infections and lower antimicrobial use. In addition to these factors, changes in the delivery of health services meant fewer people who needed antimicrobials were diagnosed or treated. With these and other dynamics to consider, research would be needed to understand the full impact of the COVID-19 pandemic on antimicrobial use and AMR.
In November 2022, the COVID-19 Evidence Network to support Decision-making (COVID-END) published its first in a series of reports to provide decision-makers with the best evidence to inform AMR research and policymaking in response to the COVID-19 pandemic. Using a living synthesis model allows for a rapid assessment of evidence while the pandemic continued but also provided an opportunity for regular updates to the evidence as new research and data becomes available. The latest update to the living synthesis was published in May 2023 and the next update is planned for November 2023. These analyses are jointly conducted by the AMR Policy Accelerator and the Knowledge Synthesis and Application Unit (KSAU) team at the University of Ottawa.
Preliminary Findings (May 2023)
- Antimicrobial use was lower for all countries in 2020 than it was before the pandemic but early 2021 data show that community use (prescribed outside of a hospital or emergency-room setting) for some countries increased in 2021 over 2020 levels.
- Further study and data are needed to clearly assess if AMR increased or decreased overall during the pandemic. Some countries found that AMR increased, while others found it decreased or stayed the same. This may be due to the differing public health measures implemented in different countries during the pandemic (e.g. mask use, lockdowns, reductions in services).
What information is needed now?
- More studies to find out how the COVID-19 pandemic has impacted AMR.
- In all countries, better systems are needed to track antimicrobial use and AMR.
- More studies on how the pandemic and AMR may have impacted different groups of people including different genders and minority groups.
Rapid Coping Review: The Effects of the COVID-19 Pandemic on the Three Core Drivers of AMR